2018 CPC Program Performance and 2019 CPC Activity Requirement Reviews
February 27, 2020Revised February 28, 2020
Agenda
2018 Program Performance
2018 Practice Monitoring Results
2019 Practice Monitoring Updates
What’s Next and Reminders
2018 Program Performance
Provider Recap
Provider Types (PT) Number of ProvidersHospital (01) 03
FQHC (12) 70
Clinic (50) 06
Professional Medical Group (21) 66
Total 145
A total of 145 CPC providers enrolled in CPC for 2018 program year
2018 Breakdown of Spend
145 Medicaid CPC Providers
1 Projected based on current attribution for 2019 enrolled practices based on 2017 average spend
Total Program Spend$89,521,284.83
1,603,355 Medicaid lives covered
$45,781,995.00 Quarterly PMPMs
$43,739,289.83Shared Savings
Shared Savings Relative to Peers
Lowest 10% Total Cost of Care (TCOC) Threshold: $317.41Practice Name Risk Adjusted TCOC
PMPM (with quarterly PMPMs)
Shared Savings Payment
METROHEALTH SYSTEM $305.60 $451,518.75
ADENA MEDICAL GROUP LLC $316.82 $69,418.33
TOTAL $520,937.08
Shared Savings Relative to Self
Practice
Shared Savings TCOC PMPM Target
(with Adjustment Factor and Minimum Savings Rate)
Risk Adjusted TCOC PMPM(with Quarterly PMPMs)
Shared Savings Payment
THE CLEVELAND CLINIC FOUNDATION $396.72 $347.74 $16,151,937.09
CHILDRENS HOSP MED CTR $461.02 $421.98 $7,382,004.23
METROHEALTH SYSTEM $310.68 $305.60 $6,698,825.94
PROVIDENCE MEDICAL GROUP INC $423.29 $373.13 $5,285,358.35
CHILDRENS HOSP MED CTR‐ARKON $396.09 $380.70 $3,778,618.80
PREMIER PHYSICIANS CENTERS INC $367.07 $343.35 $2,042,280.68
PARTNERS PHYSICIAN GROUP $373.35 $365.15 $1,232,018.20
UNIVERSITY OF TOLEDO PHYSICIANS, LLC $390.46 $386.85 $444,145.50
FIVE RIVERS HEALTH CENTERS $355.04 $351.59 $203,163.96
TOTAL $43,218,352.75
CPC Program Clinical Quality MeasuresCategory Measure 2017 2018
Improved in 2018
Well‐Child Visits in First 15 Months of Life 56.88% 62.43% 5.55%Well‐Child Visits in the 3rd, 4th, 5th, 6th years of life 68.43% 70.71% 2.28%Adolescent Well‐Care Visit 45.53% 45.24% ‐0.29%Weight assessment and counseling for nutrition and physical activity for children/adolescents 24.21% 37.96% 13.75%Timeliness for prenatal care 70.65% 75.13% 4.48%Live Births Weighing Less than 2,500 grams 9.84% 10.11% 0.27%Postpartum Care 55.27% 57.02% 1.76%Breast Cancer Screening 57.64% 55.89% ‐1.75%Cervical Cancer Screening 57.37% 58.72% 1.35%Adult BMI 29.30% 40.25% 10.95%Controlling high blood pressure 11.01% 11.17% 0.16%Med management for people with asthma 33.46% 41.85% 8.40%Statin therapy for patients with cardiovascular disease 74.55% 77.09% 2.54%Comprehensive diabetes care: HbA1c poor control (>9.0%) 93.41% 82.43% ‐10.98%Comprehensive diabetes care: HbA1c testing 84.89% 87.86% 2.98%Comprehensive diabetes care: eye exam 45.24% 47.85% 2.60%Antidepressant medication management 51.67% 52.24% 0.57%Follow up after hospitalization for mental illness 49.71% 31.74% ‐17.97%Preventive care and screening: tobacco use: screening and cessation intervention 15.39% 32.06% 16.67%Initiation and engagement of alcohol and other drug dependence treatment 41.48% 44.83% 3.36%
Pediatric Health
Women's Health
Adult Health
Behavioral Health
Improved in 15 of 20 measures
Remained within +/‐ 0.5% in 3 measures
Need improvement in 2measures
CPC Program Efficiency Metrics
Metric 2017 2018Improved in
2018Emergency Department Visits / 1,000 Member Months 90.50 87.20 ‐3.30Behavioral health‐related inpatient admits / 1,000 Member Months 1.58 1.67 0.09Ambulatory care‐sensitive inpatient admits /1,000 Member Months ages 18 years and older 1.47 1.50 0.03Generic dispensing rate 80.00% 86.00% 6.00%
Improved in Emergency Department (ED) Visits Decreased by 3.30 Visits/1,000 Member Months 39,187 ED Visits avoided in 2018
Improved in Generic Dispensing Rate Remained within +/‐ 0.1 in the remaining two measures
Warning Letters Efficiency Metrics 5 CPC entities did not pass 50% Warning notices have been issued
Quality Metrics
System updates for 2018 HEDIS value sets has caused delay on these results At least one practice did not have at least a 50% pass rate Warning notice(s) will be issues once final results are reviewed
2018 Practice Monitoring Results
CPC Activity RequirementsMust pass 100%
Same‐day appointments The practice provides same‐day access, within 24 hours of initial request, including some weekend hours to a PCMH practitioner or a proximate provider with access to patient records who can diagnose and treat
24/7 access to care The practice provides and attests to 24 hour, 7 days a week patient access to a primary care physician, primary care physician assistant or a primary care nurse practitioner with access to the patient’s medical record
Risk stratification Providers use risk stratification from payers in addition to all available clinical and other relevant information to risk stratify all of their patients, and integrates this risk status into records and care plans
Population health management Practices identify patients in need of preventative or chronic services and implements an ongoing multifaceted outreach effort to schedule appointments; practice has planned improvement strategy for health outcomes
Team‐based care management Practice defines care team members, roles, and qualifications; practice provides various care management strategies in partnership with payers and ODM for patients in specific patient segments; practice creates care plans for all high‐risk patients, which includes key necessary elements
Follow up after hospital discharge Practice has established relationships with all EDs and hospitals from which they frequently get referrals and consistently obtains patient discharge summaries and conducts appropriate follow‐up care
Tests and specialist referrals The practice has a documented process for tracking referrals and reports, and demonstrates that it:• Asks about self‐referrals and requests reports from clinicians• Tracks lab tests and imaging tests until results are available, flagging and following up on overdue results• Tracks referrals until the consultant or specialist’s report is available, flagging and following up on overdue reports• Tracks fulfillment of pharmacy prescriptions where data is available
Patient experience The practice assesses their approach to patient experience and cultural competence at least once annually through quantitative or qualitative means; information collected by the practice covers access, communication, coordination and whole person care and self‐management support; the practice uses the collected information to identify and act on improvement opportunities to improve patient experience and reduce disparities. The practice has process in place to honor relationship continuity
Practice Monitoring Breakdown100 CPC practices participated in desk
reviewsAll new practices participated in desk reviews, in addition to others chosen to reflect diverse practice characteristics, including:• High, middle, and lower practice performance on
program elements‐ Activity requirements (from 2017 practice
monitoring)‐ Clinical quality and efficiency metrics
• Practice attributes‐ Geographic location‐ Practice size‐ School‐based health care participation
Variety of practices chosen to reflect diverse practice characteristics, including• Accreditation (NCQA, Joint Commission)• Other PCMH program participation (e.g.,
CPC+, SBHC, 2017 Ohio CPC)• Prior on‐site review during 2017 program
year• Practice specialty (e.g., pediatric, BH ‐
integrated)• Practice characteristics (e.g., size, location)
30 of the 100 CPC practices interviewed participated in on‐site
visits
Statewide Results Summary The majority of CPC practices met all of the activity requirements for the program in 2018 94% of practices scored at least “1” for every element
Four providers created and successfully performed improvement performance plans On several activity requirements, practices had room for improvement
Risk stratification – most practices performed some kind of risk stratification but did not incorporate payer data or use risk scores in the patient care plan
Tests and specialist referrals – most practices performed proactive communication and follow‐up but performed less well on the tracking element
Follow‐up after hospital discharge – practices had room for improvement in the “admissions, discharges, and transfers data” element, which requires that they proactively and consistently obtain ADT summaries from hospitals and other facilities
There was variation on performance within certain activities Lower average score on the “weekend hours” element of the same‐day appointments activity
Statewide Summary Report Results
Practices perform better on some elements than on others
• Higher performance on “same day appt” and “appt within 24 hours of request”
• Lowest average score on “weekend hours”
Activity #1 Example:Same‐day
appointments
Practice Innovations From 2018 Practice MonitoringSame‐day appointments
One CPC practice used a virtual system that allowed patients to have virtual appointments 24/7 over the phone or through video conferencing
Included diagnosing, treatment recommendations, and prescribing for non‐emergency medical issues.
Patient simply needed a laptop, tablet, or smartphone
Follow‐up after hospital discharge
One CPC practice employs two patient advocates who visit patients in ED to help coordinate post‐discharge plans and care coordination
Provided information to patients on appropriate ED usage and same‐day appointments
Helped schedule follow‐up appointments with PCP (including for patients who did not have an established PCP)
2019 Practice Monitoring Updates
Overview of Practice Monitoring When practices join CPC, they must attest to meeting the CPC activity requirements
The activity requirements focus on practice processes and activities that lead to coordinated and patient‐centered primary care
Unlike the clinical quality and efficiency metrics, CPC practices must meet 100% of the CPC activity requirements
Practice monitoring is the process ODM uses to assess CPC entity performance on the CPC activity requirements
Along with assessing performance, practice monitoring gives practices the opportunity to receive technical assistance to improve their execution of the activity requirements
ODM also uses practice monitoring to identify practices using innovative strategies to care for their patients
ODM selects a vendor to perform practice monitoring
In 2018, ODM worked with HSAG to complete practice monitoring. In 2019, ODM worked with QSource
Practice Monitoring ProcessThis process is designed to assess whether a practice is meeting activity requirements
Reporting
Provider response
Onsite reviews
Desk reviews
Activity requirement monitoring
1
2
3
4
Structured assessment questionnaire
Phone discussion and review of relevant documents
Lower‐scoring practices on the onsite reviews must submit a performance improvement plan
Practices may contest results of monitoring reports through reconsideration process
Written report from each desk review
Detailed discussion of how activity requirements are or are not being implemented
Opportunity to observe and learn from innovative practices, or observe activities for practices where desk reviews indicate improvement is needed
Practice Monitoring UpdatesODM partnered with a new vendor, QSource, for practice monitoring in 2019, beginning in August
• QSource is a private, nonprofit healthcare quality improvement and IT consultancy
• This organization will analyze and evaluate aggregated information on quality and access to health care services for Medicaid members
Evaluation methodology was refined for CPC practices for the 2019 practice monitoring• QSource completed 157 Desk reviews and 74 on‐site reviews
• Timeline for 2019 was pushed back due to delays in the state budget
10/1/2019 6/30/202011/1/2019 12/1/2019 1/1/2020 2/1/2020 3/1/2020 4/1/2020 5/1/2020 6/1/2020
Practice Selection
On‐site Reviews
Desk Reviews Performance Improvement Plans Created & Implemented
Provider Reports Finalized
State Summary Report
2019 practice monitoring timeline
Activity Requirement Elements Breakdown Activity 2: Risk Stratification example
Each activity has several elements
The score sheet defines different levels of
performance for each element, in addition to any
innovative solutions practices may be using
Blue 5 Points High Performing PracticeGreen 3 – 4 Points Meeting ExpectationsYellow 1 – 2 Points Opportunity for Improvement Red 0 Points Improvement Needed
Providers use risk stratification from payers in addition to all available clinical and other relevant information to risk stratify all their patients and integrates this risk status into records and care plans:
Practice Monitoring Reports
Practices who undergo practice monitoring will receive reports on their performance
Reports will show overall performance on each activity requirement• The heat map table shows performance on each element of each activity
requirement• The general comments section shows how practices are meeting acceptable
evidence for each requirement
Reports also reflect innovative practice activities and practice feedback• Reports highlight activities where practices are using innovative methods to meet
the activity requirements• The general comments section gives practices a chance to offer feedback on
feasibility and implementation of program requirements
What’s Next and Reminders
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Upcoming Key Dates
2020 PMPM Payments
Q2 Payments will go out by the end of:
April 2020
Don’t Forget
In‐Person Learning Sessions coming
Around July/August 2020
2020 Attribution
Q2 Files will post on the MITS Portal in:
April 2020
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CPC 2020 WEBSITE INFORMATION
Additional detail on the CPC program available on the CPC website: http://medicaid.ohio.gov/Providers/PaymentInnovation/CPC.aspx
Learn more about: – CPC enrollment
– CPC payment
– CPC requirements
– CPC reporting
– CPC provider webinars
Don’t Forget to Signup for our CPC Listserv to receive all the important
communication for the 2020 program year.
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QUESTIONS?
If you have any questions, you will need to contact our provider assistance team via the IVR at, 1‐800‐686‐1516,
option 5. You must enter two of the following: tax ID, 7 digit Medicaid ID, or NPI in order to authenticate and speak with
a representative